Table 11.

Orthopedic Conditions. Shown are the diagnosis, evaluation, and treatment of common orthopedic conditions.

	Diagnosis	Evaluation	Treatment
Blount's Disease [[93], [94], [95]]	•Early walking (before the age of 12 months) in a child with severe obesity •Dome-shaped metaphysis, open growth plate and disruption of the continuity between the lateral borders of epiphysis and metaphysis, with inferomedial translation of the proximal tibial epiphysis	•Anterior/posterior (AP) and Lateral views of the tibia	•Surgical correction
Slipped Capital Femoral Epiphysis (SCFE) [[96], [97], [98]]	•Hip pain or limp: consider referred pain to groin, knee, limb •Male:Female ratio = 1.5:1 •Age of onset Males = 12.7–13.5 years •Age of onset Females = 11.2–12 years •Severe obesity at 5–6 years old: 5.9 times greater risk of SCFE compared with those with a normal BMI •Severe obesity at 11–12 years had 17.0 times the risk of SCFE	•AP and Lateral views of the hips •Ultrasound •Degree of severity depends on avascular necrosis and/or instability	•Surgical emergency (In situ pinning) •Intertrochanteric osteotomy
Scoliosis [99]	•Physical findings may be obscured by obesity •Increased curve magnitude at presentation	•Traditional Adam Forward Bend Test •Shoulder height asymmetry or use of a scoliometer	•Brace vs determine whether curve is great enough to require surgery (>45°)
Pes Planus [100,101]	•More prevalent in children with overweight/obesity compared to normal weight controls; prevalence estimates 4–28%.	•Should be evaluated with the patient standing/weight-bearing •Evaluate for presence of symptoms (i.e., pain, decreased endurance)	•If symptomatic, orthoses to control excessive pronation, stretching exercises